Delaware’s opioid crisis

“It is perhaps the defining feature of someone my age and from my state to have a friend, sibling, or cousin who has died from opioid addiction.”

Jenn was in the midst of preparing instructions for her replacement at work — she had just gotten a new job — when she received the call. A police officer was on the line. “You need to come to the hospital,” he told her. “Your son has been brought here.”

At first she thought her son, Luigi, might have been in a car accident. But when she arrived at the hospital that day in the fall of 2011, she learned Luigi had overdosed on heroin, and was in a coma and on life support.

Almost immediately upon visiting him in the intensive care unit, Jenn knew that he was gone. “I wanted there to be a chance, but when I was in the room, I felt like he was above me,” she said. “He just wasn’t there. He was like a shell, it was like his soul had already left the body.”

Luigi was my best friend (his name has been changed at the family’s request). We met in the awkward first days of our freshman year at Mount Pleasant High School in Wilmington, Delaware. He was one of the sharpest and wittiest people I’ve ever known. In the months leading up to his death, we hadn’t hung out as much. About a week before his overdose, he messaged me online to tell me that he was trying to get sober, but was dopesick and hurting.

In the days after Luigi’s overdose, doctors struggled to find out how much brain activity he had and if there was any way to save his life. Whenever I wasn’t in class, I was at the hospital with his family. A little over a week later, I received a call from another friend as I was walking into a class at the University of Delaware. I went numb, and proceeded to watch myself stumble up to my professor and tell him that I had to leave because my friend was going to die. The next morning, Luigi’s family took him off life support. He was 21.

The author met Luigi and Ryan at Mount Pleasant High School in Wilmington, Delaware, where at the time it was easy to get drugs.
Pete Voelker / The Outline

Another of my friends, Ryan, was fresh off a stint in rehab when he did the heroin with Luigi that resulted in the fatal overdose. When he woke up the next morning, he found Luigi blue in the face. He wasn’t breathing. After Luigi died, Ryan went back to rehab, and was later discharged to a recovery house in Pennsylvania. “My parents didn’t know what to do with me [when it happened],” he told me. “They didn’t know what to do with me before one of my very closest friends overdosed.”

The last time she saw Luigi, Jenn said, he felt sick and cut their visit short. She thinks he was high. “The way he said goodbye, it wasn’t him. It was just this deep sadness,” she said. “His eyes were so unbelievably sad.” Later, as his family cleaned his apartment while he was in the hospital, they found a note containing the numbers for three different rehab facilities.

“People are all too quick to say that this could never happen to them,” Jenn said. “They’re completely wrong. I always felt like if anything could happen, it could happen to me.”

I expected Luigi to be the best man at my wedding and godfather to my children, not to die when we were 21. His funeral was my introduction to a world in which I’d be burying friends long before it was their time to go; at this point, nearly everyone I know from Wilmington has a similar story. It is perhaps the defining feature of someone my age and from my state to have a dead sibling, cousin, or friend.

Although the opioid crisis has disproportionately affected economically distressed areas in Appalachia and the Rust Belt, Delaware –– a state known mostly for being a tax haven for corporations –– has been hit hard as well. The flood of prescription opiates into pharmacies, the availability and cheap cost of heroin, and the more recent explosion of the much more powerful and lethal drug fentanyl have produced staggering rates for opioid abuse and overdose deaths in the country in Delaware. In 2014, the state had 21 overdose deaths per 100,000 people, nearly three times its 2004 rate of 7.6. It’s a common story for the area in general; Philadelphia, which is 25 minutes north of Wilmington, had the highest overdose rate last year of any major U.S. city.

I expected Luigi to be the best man at my wedding and godfather to my children, not to die when we were 21.

Luigi, Ryan, and I graduated from high school in 2008, shortly before the stock market crashed. Despite its corporate-friendly reputation, the recession hit Delaware particularly hard; from 2009 to 2014, it was the only state in the country in which wages actually decreased. Ryan worked various minimum-wage jobs, including at a pet store with Luigi, while other friends of ours went off to prestigious colleges. “In the back of my mind I was thinking, ‘I’m going to be making fifteen-to-twenty grand a year when I’m 40 years old,’” Ryan told me over the phone from his home in Florida. “It was a lot of financial insecurity and intellectual insecurity that played into my own mental health, my own confidence and self-worth.”

Luigi and Ryan had been friends since kindergarten. Ryan was outgoing and athletic; we played lacrosse together, and by our senior year he was a team captain. “I had hopes that [lacrosse] was my ticket into college, because I didn’t do too hot in high school,” he said. Those hopes were dashed, however, when he tore his ACL in the first preseason game of our senior year.

Delaware’s top five zip codes for “heroin-related incidents,” according to the DEA, include working class communities as well as one of the wealthiest communities in the state. Pictured here is downtown Wilmington.
Pete Voelker / The Outline

For a semester after we graduated, all three of us attended Wilmington University, a local commuter college, and took the same basic art classes – Luigi because he wanted to, Ryan and I because we had no idea what we going to do with our lives – before I dropped out.

Luigi was Ryan’s polar opposite; he was much more quiet and guarded until he got to know you. We both played the same kinds of video games, and were into indie rock and the same style of comedy — he introduced me to both Tim and Eric and Trailer Park Boys. He was somewhat uncomfortable with having serious conversations, but was deeply passionate about helping people; his favorite job he ever had, he once told me, was working at a summer camp for kids with cerebral palsy. He was also exceptionally close with his mother and older sister, Brittany.

It was easy to buy drugs at my high school. Painkillers such as OxyContin and Percocet and other drugs like Xanax and Adderall were readily accessible. Kids sold pills prescribed for themselves or their parents out of their houses or in school hallways.

Ryan experimented with these and other drugs in high school. He said there were various points where he was doing pills before school, but he never saw it as a particular problem. After he tore his ACL, he had to have surgery and was prescribed a low dosage of Percocet. He took all of his prescription within a day or two of getting it.

It was easy to buy drugs at my high school.

Ryan said that his pill use didn’t get out of control until a year or so after he graduated from high school. “Then it was like, ‘this is all the time,’” he recalled. “Every dollar that I got from the minimum-wage job I was working [went to drugs].”

Eventually, Ryan said, he was using constantly and going through terrible withdrawals when he wasn’t. “That’s when you start delving into, ‘let me steal this $20 off the table,’ or ‘let me sell this jewelry that’s been lying around for a while. Let me pawn everything that people won’t notice,’” he said.

Ryan tried to quit repeatedly. He recounted multiple times when he would buy suboxone (a drug that treats opioid dependency) from someone with a prescription before going on a vacation, only to blow through the entire supply in the first few days. He would spend the rest of his trip going through the excruciating withdrawal process, which produces flu-like symptoms like hot- and-cold sweats, vomiting, and diarrhea. “At a certain point, [opioid addiction] isn’t just about getting high, it’s about not getting sick,” said Dr. Lynn Fahey, who serves as the CEO of Brandywine Counseling and Community Services, a treatment center and facility in Wilmington, and has been at the organization since the early ‘90s. “It’s about, ‘How do I get out of bed today?’”

In 2014, Delaware had 21 overdose deaths per 100,000 people, nearly three times its rate in 2004.
Pete Voelker / The Outline

Luigi started doing pills around the time we were 19 or 20. Although he was wary of alcohol and only started drinking infrequently around the time he turned 21, he didn’t have the same hesitancy when it came to pills. His tolerance, however, was still pretty low compared to Ryan’s. “We would hang out and he would buy one or maybe two [pills],” Ryan remembered. “I would tell him I was buying one or two, but I’d buy six.”

I noticed as both Luigi and Ryan became increasingly withdrawn. Luigi quit his job at the pet store after deciding that he could live off his savings for a bit; Ryan would hang out and then disappear for 30 minutes, or bail on a plan altogether without notice. I also watched their dependencies — of which, at the time, I had no real sense — warp them into different people. Whenever they weren’t using, they were dour and generally pissed off, snapping at their friends and starting arguments over minor things. When they were high, they were euphoric, elated in a way that completely disconnected them from whomever they were with.

One night in the spring of 2011, I walked into Luigi’s kitchen to find him and Ryan snorting OxyContin. They tried to conceal what they were doing and asked me not to say anything to our other friends. I left Luigi’s apartment a little later, and only saw them sparingly over the following months. That summer, I learned Ryan was in rehab.

Jenn said Luigi told her he was addicted to painkillers the winter before he died. “I’ve been taking OxyContin,” he told her, “and I didn’t think it would be a big deal, but now I’m sick all of the time.” Jenn said she was “shocked and sad and scared” when he told her. They discussed various options, including methadone, natural and alternative treatments, and rehab, but he decided to try to overcome it through sheer willpower. “He said, ‘Let me try this on my own and see if I can beat it,’” she recalled. “He felt like he could get a handle on it, he just needed a little bit of time.”

Ryan said he remembers going and picking the heroin up the night Luigi overdosed, but little else. “I remember going back to the house, and then I remember waking up the next morning in a panic,” he said. “He was pretty much blue in the face and not breathing.” The following months, he said, were the worst in his life. “I wish I could say I stayed sober after that, that my best friend dying helped get me sober, but no,” he said. “If I didn’t think about it, it didn’t happen.”

According to the Center for Disease Control and Prevention, Delaware had the ninth-highest drug overdose rate in 2016; the death rate was a 40 percent increase from the year before. Nationwide, drug overdoses accounted for about 64,000 deaths in 2016, a 22 percent increase from 2015, and roughly 40,000 of those deaths can be attributed to opioids. In the 12 months leading up to January 2017, Delaware reported 309 overdose deaths, a 71-percent increase over numbers reported in January 2016 and the highest of the 22 states that reported overdose numbers. Delaware, as a whole, is home to less than a million people.

Lynn Fahey, CEO of Brandywine Counseling and Community Services, a treatment center in Wilmington.
Pete Voelker / The Outline

As demand for heroin has grown in the state, so too has the prevalence of the much more dangerous fentanyl, which is estimated by the Drug Enforcement Administration to be up to 50 times more powerful than heroin. In 2016, the state saw 120 fentanyl-related deaths, which accounted for more than a third of Delaware’s 308 overdose deaths that year. Delaware had the steepest increase in fentanyl deaths in the country, a 186 percent increase over the previous year’s deaths. Nationally, according to the CDC, fentanyl overdoses in 2016 were up over 100 percent from the year before and accounted for more than 20,000 deaths, the most of any drug. “Often, people don’t even know there’s fentanyl in their drugs,” said Fahey. “It’s not that people are seeking it, it’s being added by the drug dealers.”

Delaware had the ninth-highest drug overdose rate in 2016.

Dr. Tammy Anderson, a University of Delaware sociology professor who studies drugs, alcohol, and crime, said that while younger users generally start with pills and turn to the much cheaper heroin — according to the DEA, one 30-milligram OxyContin pill can cost up to $40, while a bag of heroin in Wilmington can go for as little as $5 — the ways people become addicted varies with age. “The profile [for older people] is overprescription of painkillers combined with benzodiazepine sedatives, complicated by medical conditions,” she said. From 2006 to 2014, opioid pain relievers accounted for more drug overdoses in Delaware than “illicit” drugs, according to the Delaware Department of Health and Human Services; nationally, the CDC has said that 80 percent of injection heroin users started on prescription opiates.

Helping to fuel the crisis has been the overprescription of opioids. According to a CDC report from 2014, in 2012 there were nearly nine high-dose opioid pain reliever prescriptions for every 100 people and 21.7 extended-release opioid pain reliever prescriptions for every 100 people, the highest and second-highest rates in the country. In both 2014 and 2015, the top 10 percent of prescribing providers wrote nearly two-thirds of the opioid prescriptions for the entire state, according to the Delaware DHHS. It was only this year that Delaware unveiled tougher new prescription guidelines for opiates.

Anderson also said that the opioid crisis has changed the way we think about who addiction affects; the state’s top five zip codes for “heroin-related incidents,” according to the DEA, include the working class community of Claymont as well as Hockessin, one of the wealthiest communities in the state. “In the past, we’ve always argued that addiction was a result of people living in dire situations and turning to drugs as a coping mechanism or a way to raise money,” Anderson said. “The interesting thing about this epidemic is that it cuts across class lines, and I think there’s different explanations for different populations.”

A majority of the people I know who became addicted, including Luigi and Ryan, have been young white men from middle-class backgrounds. That does not mean, however, that it’s only white men who have been affected: The New York Times reported last December that in 2016, the drug death rate rose 41 percent among black Americans living in “urban counties,” as opposed to a 19 percent increase among whites living in those same counties. In Fahey told me the current population of her facility, which is largely made up of people who are uninsured or on Medicaid, is 50 percent white and 35 percent black.

Hopeful messages at the Brandywine Counseling and Community Services treatment center in Wilmington, Delaware encourage people battling addiction.
Pete Voelker / The Outline

But because of the notion that the crisis is mostly affecting white people, some of whom became addicted via legally obtained prescriptions, there’s been a shift in attitudes towards rehabilitation and treatment and away from punitive measures that have dominated Delaware’s approach in the past. In 2016, for example, Delaware eliminated mandatory life sentences for drug offenders.

Existing state law, however, still arbitrarily includes tougher penalties for drug offenses committed within 1,000 feet of a park or church, which state Senate Majority Leader Margaret Rose Henry said last year “has a disproportionate impact on low-income and minority residents [of Wilmington].”

The reforms that are being made, though, are happening partially because of work being done by a group of activists who have been through incredible personal tragedies.

On Dave Humes’ birthday, May 21, 2012, he was supposed to go to a Philadelphia Phillies game with his son Greg. Instead, Humes met with a detective to collect Greg’s belongings. Greg had died in the passenger seat of his own car in the parking lot of a hospital two days earlier from a drug overdose. He had been sober for 17 months.

“[The people Greg was with] drove him to the hospital, and then just walked away,” Dave told me. “They didn’t fix the key fob so the horn would go off, they didn’t press the emergency room door, they didn’t walk a block away and call and say, ‘Go look in your parking lot.’ And by the time he was discovered it was too late.”

When he collected his son’s things, Dave said, the detective told him that two things might have been able to save his son’s life: a Good Samaritan law, which would have protected the people Greg was with from prosecution had they called 911, and a law expanding access to naloxone, an opiate overdose reversal drug also known under the brand name Narcan. At the time, Delaware law allowed for neither of those things.

Before long, Humes was involved in atTAcK addiction, a nonprofit he describes as an “action organization” that lobbies the state government for more humane drug laws. It was formed in February 2013 by Don and Jeannie Keister, whose son, Tyler, had died two months earlier from a heroin overdose. Dave serves as a public policy coordinator and naloxone trainer for the group, which operates three transition and recovery houses in Delaware.

Dave Humes’ son Greg died of an overdose in 2012. Humes is now a public policy coordinator and naloxone trainer for atTacK addiction.
Pete Voelker / The Outline

A frisbee tournament is held in Wilmington to commemorate the death of Humes’ son Greg.
Pete Voelker / The Outline

Dave Humes’ son Greg died of an overdose in 2012. Humes is now a public policy coordinator and naloxone trainer for atTacK addiction.
Pete Voelker / The Outline

A frisbee tournament is held in Wilmington to commemorate the death of Humes’ son Greg.
Pete Voelker / The Outline

Upon its formation, atTAcK immediately began lobbying the state legislature; their first proposal was a Good Samaritan law, something Dave said was a no-brainer because it wouldn’t cost the state anything. “Who could argue against saving lives?” he said. The bill passed and was signed into law in the summer of 2013. The next year, the group focused on increasing access to naloxone to both police and citizens. By the end of the 2014 legislative session, then-Governor Jack Markell had signed laws doing just that.

According to Humes, there were 82 documented cases of reversed overdoses in 2015, the first full year the laws were in effect. The next year, according to the state DHSS, naloxone was administered 1,535 times.

Within two years, a grassroots group of grieving family members — whose funding, Humes said, largely comes from a 5k race the group holds every March — had helped to spur momentous progress on reforming the state’s draconian drug laws. There were at least 233 overdoses statewide last year; although the final number is likely to be higher due to delays in toxicology reports, it’s expected that Delaware will see a decrease in overdose deaths for the first time since 2012.

After Luigi’s death, Ryan’s sobriety didn’t stick, and once he moved back to Delaware the next year, he started using again. He stole his mother’s wedding ring and his father’s wedding band to buy drugs, only to be caught all of three hours later. Finally, his parents put him on a flight to rehab in Florida. Before he got on the flight, his father gave him $40. “This is all I can give you,” he recalled his father saying to him. “You’ve taken everything from us.”

Ryan told me he hasn’t used since he moved to Florida. When I asked what’s driving his sobriety, and how he’s stuck with it for so long this time, he said there’s not just one thing to which he can point. “It’s the hardest question to answer, and the one everyone always asks me,” he said. “I think it’s just a compilation of a bunch of events, situations, the environment I was in, my own personal headspace… but getting out of the area 100 percent helped.” He started working at rehab facilities himself, and has helped several friends and acquaintances of ours from Delaware get into treatment; recently, he got married.

Finally, Ryan’s parents put him on a flight to rehab in Florida.

A few years ago, Jenn and her family moved to California. “I have this beautiful room in my house and I have his giant portrait up, and it’s a quiet sacred space,” she said. “I figured that would be my space for me to be close to him and remember him, but I can’t bring myself to do that. The pain is just too bad.”

But she remembers one specific detail from the eulogy she gave at Luigi's funeral that has stuck with her for the past six years. “You should wake up every day and try to be the best version of yourself, to honor him,” she said. “He was deeper and more compassionate than anybody I’ve ever met.”

I still feel pangs of guilt when I think about Luigi, and how I didn’t know how to deal with the sharp, funny guy I knew becoming an addict, or how to help him. I imagine the person he would have become, and the roles he, Ryan, and I would’ve played in each others’ lives as we got older and navigated adulthood.

The last time I saw Luigi in person was right before my grandmother’s funeral, a few weeks before he died. “It’s not the last time you’ll see her,” he told me in an uncharacteristically earnest tone. “You’ll see her in your dreams sometimes.”

He was right. And now, when I dream about him, he’s happy in the way I didn’t see much in the year leading up to his death, in a way in which the passage of time has left me unable to know whether I ever saw him that vibrant and carefree and glad to be alive. In these dreams, he is smiling.